Old Evil, New Twist - Return to Home Page - Breast Cancer Action

2 FROM THE EXECUTIVE DIRECTORNot ChronicTreating Breast Cancer as a Recurrent DiseaseBy Barbara A. BrennerAs everyone familiar with breast cancer knows, there is noavailable cure for metastatic breast cancer (breast cancerthat has spread beyond the breast to life-sustainingorgans). In fact, metastatic breast cancer will kill awoman who has it unless something else kills her first.The good news is that some treatments can extend the lives ofsome women with metastatic disease by keeping metastaticbreast cancer from advancing, at least for a period of time. Thesetreatments are not without side effects, however. Some of thoseside effects are devastating.One thing I find interesting at this moment is that advances intreatment have led the cancer industry to begin to talk of breastcancer as a “chronic disease.”The term “chronic” appears to have many meanings. The use ofthe term in the context of breast cancer—metastatic or not—conveys an approach to, and an attitude about, the disease thatpoints in the wrong direction.Consider how Wikipedia defines “chronic” in the medicalsetting:A chronic disease is a disease that is long-lasting or recurrent.The term “chronic” describes the course of the disease, or its rateof onset and development. A chronic course is distinguishedfrom a recurrent course; recurrent diseases relapse repeatedly,with periods of remission in between.By this definition, metastatic breast cancer is recurrent, notchronic. While this might seem like an academic dispute,consider it from the viewpoint of a woman with metastaticbreast cancer. Rita Arditti, a cancer activist and active memberof the Women’s Community Cancer Project in Boston, and awoman living with metastatic breast cancer, has this to say onthe subject:Cancer is a progressive disease regardless of “personalmanagement” of the disease. In the case of diabetes, lifestylechanges (diet, exercise) are crucial because many times theycan allow the patient to avoid insulin or other treatments.Apparently, heart disease is in the same boat:lifestyle changes are crucial and, in many cases, havebeen able to control the disease.What are the lifestyle changes I can make thatwould put me in that boat? In fact, the whole issueof patient compliance is key for people with chronicillness. For cancer patients, I guess compliancemeans showing up for chemo or taking your pills.The other important point is that the treatments forcancer are, in some cases, worse than the diseaseand that secondary cancers are often a result of thetreatment of the first cancer. Injecting insulin daily isno fun, but the side effects of some cancer therapiesare frankly horrendous, and the uncertainty of theireffectiveness adds to the burden.It is one thing is to take insulin or some othertreatment that is known to help. But cancer patientsoften receive treatment with only the “hope” that itwill improve their cancer outcome, which may meanmonths of bad side effects for nothing. That adds abig stress factor to the whole picture. Uncertainty isall over the place with cancer, regardless of attitude,because we know so little and can do practicallynothing to improve the situation. Not having anycontrol is in itself terribly debilitating.continued on page 11